Organization which receives a substantial part of its support from a governmental unit or the general public

Organization

Corporation

Exempt Organization Status

Unconditional Exemption

Tax Period

12/2013

Assets

$500,000 to $999,999

Income

$100,000 to $499,999

Filing Requirement

990 (all other) or 990EZ return

Asset Amount

$664,357

Amount of Income

$109,212

Form 990 Revenue Amount

$109,212

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Financial snapshot ($)

Revenue for 2013

Assets at the end of 2013

Functional expenses for 2013

Support schedule

Checklist

2012

2013

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?

No

Yes

Is the organization required to complete Schedule B, Schedule of Contributors?

No

No

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office?

No

No

Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year?

No

No

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19?

No

No

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts?

No

No

Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures?

No

No

Did the organization maintain collections of works of art, historical treasures, or other similar assets?

No

No

Did the organization report an amount for escrow or custodial account liability; serve as a custodian or provide credit counseling, debt management, credit repair, or debt negotiation services?

No

No

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments?

No

No

Did the organization report an amount for land, buildings, and equipment?

No

No

Did the organization report an amount for investments-other securities that is 5% or more of its total assets?

Yes

Yes

Did the organization report an amount for investments-program related that is 5% or more of its total assets?

No

No

Did the organization report an amount for other assets that is 5% or more of its total assets?

No

No

Did the organization report an amount for other liabilities?

No

No

Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?

No

No

Did the organization obtain separate, independent audited financial statements for the tax year?

No

No

Was the organization included in consolidated, independent audited financial statements for the tax year?

No

No

Is the organization a school described in section 170(b)(1)(A)(ii)?

No

No

Did the organization maintain an office, employees, or agents outside of the United States?

No

No

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more?

No

No

Did the organization report more than $5,000 of grants or other assistance to or for any foreign organization?

No

No

Did the organization report more than $5,000 of aggregate grants or other assistance to or for foreign individuals?

No

No

Did the organization report a total of more than $15,000 of expenses for professional fundraising services?

No

No

Did the organization report more than $15,000 total of fundraising event gross income and contributions?

Yes

Yes

Did the organization report more than $15,000 of gross income from gaming activities?

No

No

Did the organization operate one or more hospital facilities?

No

No

Did the organization attach a copy of its audited financial statements?

No

No

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government?

Yes

Yes

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals?

No

No

Did the organization answer 'Yes' about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees?

No

No

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002?

No

No

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?

No

No

Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds?

No

No

Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year?

No

No

Did the organization engage in an excess benefit transaction with a disqualified person during the year?

No

No

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?

No

No

Did the organization report any amount for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons?

No

No

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons?

No

No

Was the organization a party to a business transaction with one of the following parties

A current or former officer, director, trustee, or key employee?

No

No

A family member of a current or former officer, director, trustee, or key employee?

No

No

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner?

No

No

Did the organization receive more than $25,000 in non-cash contributions?

No

No

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions?

No

No

Did the organization liquidate, terminate, or dissolve and cease operations?

No

No

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?

No

No

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3?

No

No

Was the organization related to any tax-exempt or taxable entity?

No

No

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

No

No

Did the organization make any transfers to an exempt non-charitable related organization?

No

No

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes?

No

No

Statements Regarding Other IRS Filings and Tax Compliance

2011

2012

2013

The number reported in Box 3 of Form 1096

0

0

The number of Forms W-2G

0

0

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?

No

Yes

The number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return

0

0

Did the organization file all required federal employment tax returns?

No

No

Did the organization have unrelated business gross income of $1,000 or more during the year?

No

No

No

Has it filed a Form 990-T for this year?

No

No

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?

No

No

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

No

No

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

No

No

Did the organization file Form 8886-T?

No

No

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?

No

No

Did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?

No

No

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?

No

No

Did the organization notify the donor of the value of the goods or services provided?

No

No

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?

No

No

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

No

No

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

No

No

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

No

No

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

No

No

Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?

No

No

Did the sponsoring organization make any taxable distributions under section 4966?

No

No

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?

No

No

Initiation fees and capital contributions

$0

$0

$0

Gross receipts for public use of club facilities

$0

$0

$0

Gross income from members or shareholders

$0

$0

$0

Gross income from other sources

$0

$0

$0

Is the organization filing Form 990 in lieu of Form 1041?

No

No

The amount of tax-exempt interest received or accrued during the year

$0

$0

Is the organization licensed to issue qualified health plans in more than one state?

No

No

The amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans

$0

$0

The amount of reserves on hand

$0

$0

Did the organization receive any payments for indoor tanning services during the tax year?

Total estimated amount of other compensation from the organization and related organizations

$0

$0

Total number of individuals who received more than $100,000 of reportable compensation from the organization

0

0

Total number of independent contractors who received more than $100,000 of compensation from the organization

0

0

Statement of Revenue

2011

2012

2013

Total revenue

$113,999

$108,256

$109,212

Contributions, Gifts, Grants and Other Similar Amounts

$105,590

$94,491

$92,821

Program Service Revenue

$0

$0

$0

Other Revenue

Investment income (including dividends, interest, and other similar amounts)

$8,409

$13,765

$16,391

Income from investment of tax-exempt bond proceeds

$0

$0

$0

Royalties

$0

$0

$0

Net rental income

$0

$0

$0

Net gain/loss from sales of assets other than inventory

$0

$0

$0

Net income/loss from fundraising events

$0

$0

$0

Net income/loss from gaming activities

$0

$0

$0

Net income/loss from sales of inventory

$0

$0

$0

Miscellaneous Revenue

$0

$0

$0

Statement of Functional Expenses

2011

2012

2013

Total functional expenses

$210,158

$96,021

$120,771

Grants and other assistance to domestic organizations and domestic governments

$60,000

$70,000

Grants and other assistance to domestic individuals

$0

$0

Grants and other assistance to foreign organizations, foreign governments, and foreign individuals

$0

$0

Benefits paid to or for members

$0

$0

Compensation of current officers, directors, trustees, and key employees

$0

$0

$0

Compensation not included above, to disqualified persons

$0

$0

Other salaries and wages

$0

$0

$0

Pension plan accruals and contributions

$0

$0

Other employee benefits

$0

$0

Payroll taxes

$0

$0

$0

Fees for services (non-employees)

Management

$0

$0

Legal

$0

$0

Accounting

$1,400

$1,400

Lobbying

$0

$0

Professional fundraising services

$0

$0

$0

Investment management fees

$0

$0

Other

$0

$0

Advertising and promotion

$0

$0

Office expenses

$1,686

$1,848

Information technology

$0

$0

Royalties

$0

$0

Occupancy

$0

$0

Travel

$0

$0

Payments of travel or entertainment expenses for any federal, state, or local public officials

$0

$0

Conferences, conventions, and meetings

$0

$0

Interest

$0

$0

Payments to affiliates

$0

$0

Depreciation, depletion, and amortization

$0

$0

Insurance

$0

$0

Other expenses

$15,328

$24,011

Other expenses

$7,069

$3,500

Other expenses

$8,929

$9,152

Other expenses

$1,609

$10,860

Balance Sheet

2011

2012

2013

Total assets

$599,257

$632,511

$664,357

Cash - non-interest-bearing

$111,398

$111,821

Savings and temporary cash investments

$0

$0

Pledges and grants receivable, net

$0

$0

Accounts receivable, net

$0

$0

Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees

$0

$0

Loans and other receivables from other disqualified persons, persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations

$0

$0

Notes and loans receivable, net

$0

$0

Inventories for sale or use

$0

$0

Prepaid expenses and deferred charges

$0

$0

Land, buildings, and equipment: cost or other basis

$0

$0

Investments - publicly traded securities

$0

$0

Investments - other securities

$521,113

$552,536

Investments - program-related

$0

$0

Intangible assets

$0

$0

Other assets

$0

$0

Total liabilities

$0

$0

$0

Total net assets or fund balances

$599,257

$632,511

$664,357

Unrestricted net assets

$632,511

$664,357

Temporarily restricted net assets

$0

$0

Permanently restricted net assets

$0

$0

Capital stock or trust principal, or current funds

$0

$0

Paid-in or capital surplus, or land, building, or equipment fund

$0

$0

Retained earnings, endowment, accumulated income, or other funds

$0

$0

$0

Reason for Public Charity Status (for 2013)

The organization is not a private foundation because it is:

An organization that normally receives: (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975

Number of organizations supported

0

Sum of amounts of support

$0

Support Schedule for Organizations Described in Section 509(a)(2) (for 2009 - 2013)

2009 - 2013 Total

Public support

$484,084

Subtotal

$484,084

Gifts, grants, contributions, and membership fees received

$484,084

Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose

$0

Gross receipts from activities that are not an unrelated trade or business under section 513

$0

Tax revenues levied for the organization's benefit and either paid to or expended on its behalf

$0

The value of services or facilities furnished by a governmental unit to the organization without charge

$0

Less

$0

Amounts received from disqualified persons

$0

Amounts received from other than disqualified persons that exceed the greater of $5,000 or 1% of the total support

$0

Total support

$550,789

Public support

$484,084

Subtotal

$66,705

Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources

$66,705

Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975

$0

Net income from unrelated business activities, whether or not the business is regularly carried on

$0

Other income

$0

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